CN105310769A - Surgical instrument - Google Patents
Surgical instrument Download PDFInfo
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- CN105310769A CN105310769A CN201510359500.9A CN201510359500A CN105310769A CN 105310769 A CN105310769 A CN 105310769A CN 201510359500 A CN201510359500 A CN 201510359500A CN 105310769 A CN105310769 A CN 105310769A
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- branch
- cutting electrode
- seal jaw
- electrode
- tissue
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/1206—Generators therefor
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00184—Moving parts
- A61B2018/00196—Moving parts reciprocating lengthwise
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/00595—Cauterization
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/00601—Cutting
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/00607—Coagulation and cutting with the same instrument
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/0063—Sealing
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00696—Controlled or regulated parameters
- A61B2018/00767—Voltage
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00773—Sensed parameters
- A61B2018/00892—Voltage
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
- A61B2018/1455—Probes having pivoting end effectors, e.g. forceps including means for cutting having a moving blade for cutting tissue grasped by the jaws
Abstract
A sealing instrument (10) special for fine operation process includes two branches (15, 16) with sealing jaws (19, 20, 36, 37) acted on by a sealing voltage preferably between 80 and 120 volts. Tissue receptacles (53, 54) are separated from one another by a wall-like extension (24), which at its lower edge carries a cutting electrode (31), are defined between the branches (15, 16). A cutting voltage from 300 to 500 volts is applied between a branch (16) and the cutting electrode. When the branches are closed the grasped tissue is sealed simultaneously between the sealing jaws (19, 36 and 20, 37) and is severed by the cutting electrode (31). Even though the tissue is severed completely; for example after 0.3 to 0.5 seconds and the sealing requires more time, the rolls of tissue grasped in the tissue receptacles (53, 54) act as form-fitting protection of the vessel edges in the tool (12).
Description
Technical field
The present invention relates to a kind of for sealing the operating theater instruments with parting tissue.
Background technology
The sealing instrument of specific type is used at people or the enterprising line operate of animal patient.They for clamping and seal tissue, and can also finally to heat under the effect of pressure and electric current.In addition, such apparatus can be used to the tissue separately solidifying or seal.
US2007/0078456A1 discloses a kind of like this apparatus with two removable branches, and it is for clamping hollow blood vessel.Liang Ge branch can be energized, thus between Liang Ge branch, heat hollow blood vessel that is clamped and that compress, and blood vessel wall is interconnected.The closed by this way and blood vessel therefore sealed can then be separated by removable blade in sealing area.
In order to seal blood vessels, the Liang Ge branch of instrument has smooth contact surface, and blood vessel is sealed in therebetween.This contact surface must have enough minimum widiths, thus reliably seal blood vessels.Therefore, the miniaturization of this instrument is restricted.
In addition, US6,113,598A disclose a kind of apparatus with Liang Ge branch, wherein, one (on) branch has the protuberance of strip, itself and the groove fit in the inferior division formed by two and half resilient limb.
By this apparatus, flexibly vessel end can be clamped at solidificating period.But miniaturization here is also restricted.
US2002/0115997A1 discloses a kind of apparatus especially for excision lung tissue.This apparatus has Liang Ge branch, and they can close to each other and remotely move, and Liang Ge branch all has electrode structure.This electrode structure is arranged on any side of joint-cutting, and resolution element moves by it, thus keeps clamped tissue in the mode of form fit and it sealed between branch.Like this, the upper inferior division of every side of joint-cutting all comprises positive terminal and anode connector, thus produces sealing the margin the widest as far as possible organizationally.
US8,394,094 discloses a kind of similar electrosurgical equipment, and wherein, cutting electrode has been assigned with the interfacing part that is provided with spring.
Summary of the invention
The object of the invention is to describe a kind of sealing instrument, its design allows the microminiaturization of this apparatus.
This object is realized by sealing instrument according to claim 1 and method according to claim 15.
Sealing instrument for the application of splanchnoscopy, laparoscopy or open surgery according to the present invention has Liang Ge branch.First branch has at least two enclosed electrodes, and this electrode is preferably electrically connected to each other.Second branch also has at least two enclosed electrodes, and this electrode is preferably electrically connected to each other.Branch one of them (such as, top set) has the cutting electrode support member with wall-like edge or cut edge shape.Another branch has the respective opposed bearing for cutting electrode.Enclosed electrode is installed in the edge of Liang Ge branch, thus produces sealing the margin in biological tissue.Cavity volume is organized to be formed between cutting electrode and seal jaw.These cavity volumes preferably have so a kind of volume, make to occur electric current density wherein much smaller than the electric current density between seal jaw.Electric power is passed in the tissue clamped between cutting electrode and seal jaw, and namely tissue is arranged in and organizes cavity volume, but during this process, and to be clamped in for the formation of compared with the tissue of sealing the margin between seal jaw, the described degree by the tissue contracts clamped is less.At least one crimping of organization formation, when closed branch, this crimping is approximately in the back of the first seal jaw and the second seal jaw in the mode of form fit.Organize cavity volume and organizing of wherein clamping to carry out form fit protection to the tissue be clamped between seal jaw thus, or even when only forming the taeniae telarum of very narrow sealing the margin and unusual rapid wear, also form protection.Organized before opening instrument and can not skid off from sealing instrument.
Cavity volume is organized preferably to have square-section.Seat surface and tissue scaffold face are all preferably a smooth and all preferred seal jaw from branch and extend to another seal jaw of same branches.The seal jaw that seat surface and tissue scaffold face are preferably substantially adjacent respective at a right angle.
This design also opens the probability worked together with enclosed electrode while activating cutting electrode, thus makes process of setting and cutting start at one time thus.Can be separated by cutting electrode before being organized in the sealing between seal jaw.Organizationally while cutting electrode and seal jaw action not necessarily, but be possible.The time sequencing of cutting and sealing is arranged preferably by the voltage be applied on cutting electrode and seal jaw.Sealing and disengaging time can be reduced thus, simplify work process, and apparatus is energized.Such as, can simultaneously from supply circuit to seal jaw between apply hermetic (such as 97V) and to applying killer voltage (such as 437V) between seal jaw and cutting electrode.Voltage can provide from autotransformer.First slope current is provided to distribute and then provide constant voltage during power supply.Can additionally process in a time-controlled manner.The shortest time of 1.4 seconds and/or the maximum duration of such as 2.8 seconds can be set.According to the disconnection standard be arranged on thus in time window, can clearly after the impedance first time of tissue declines and when determining the impedance again increasing described tissue, will deenergization, therefore suitably perform the time tolerance (such as, 0.4 second) of power supply.In addition, apparatus or its power supply unit can provide overvoltage and spark detection device.The spark that interim voltage drop picks out with elimination can be provided.
In addition, distinctive design is can be microminiaturized.Due at the blood vessel end organized in cavity volume or organize end to have shape mating protection, so sealing area can be limited to very narrow, be almost line style band, and do not have the risk that unencapsulated organization edge spins off prematurely from sealing instrument.
The cavity volume of organizing be formed on any side of cutting electrode has the shape that can obtain particularly preferred form fit between tissue and closed apparatus.In addition, the width of cavity volume is organized to be preferably more than the width of the wall-like extension of carrying cutting electrode.In addition, the width of cavity volume is organized to be preferably more than the width of seal jaw.This also helps reliable form fit and fully reduces the in-house electric current density being arranged in cavity volume.
Seal jaw preferably has the cross section profile of band annular transitional.Especially, seal jaw towards organize cavity volume around, avoid current convergence thus.Here, these annular sections are formed as except having lower current convergence, also likely between tissue and closed branch, realize reliable form fit.The seal jaw of Liang Ge branch preferably limits sealed airspace mutually, and it forms obtuse angle jointly.Be arranged to closest to cutting electrode seal jaw around obtaining large-sized annular radius, thus here Limited Current density accurately.If be fastened on by cutting electrode in top set, the annular radius along the inferior division organizing the direction of cavity volume to arrange can have different value compared with the annular radius of top set.But these radiuses preferably have identical value.The annular radius of the seal jaw on outside branch has the value of the annular radius be greater than along the direction of organizing cavity volume.Better can control the organizational effect outside branch thus.Due to the inclined position of sealed airspace, branch's automatically centering each other.In addition, seal jaw has along organizing the direction of cavity volume from the radius of such as 0.05mm to 0.1mm at its clamping face, thus between tissue and apparatus, obtain excellent in shape cooperation, and there is the radius from such as 0.1mm to 0.3mm on outside branch, thus obtain excellent sealing character.These clamping faces collectively define from the sealing of 0 to 0.1mm (preferably 0 to 0.05mm) or clamping gap, even thin tissue, it also allows fixed clamp.
Seal jaw can have the main body in tape insulation region, such as, be made up of the epoxy resin with the enclosed electrode arranged along a line, such as, be made up of the material of the main body of branch, such as, be made up of high-grade steel.The main body of branch is made up of solid material, or the heart for developing and printing/bending.The electrode of relative seal jaw is preferably overlapped mode can not arrange or be formed.The plug-in unit that insulating regions can be inserted by (cast member or injection member) or mold enters in branch is formed or is formed by multiple local coatings be made up of insulant.Alternatively, branch can be formed by pottery, and wherein, then branch shape becomes in the region of enclosed electrode is conduction (such as metallizing).Also can form branch by having pottery of different nature.Such as, branch can be specifically created by pottery, and wherein, branch comprises the non-conductive ceramic material of insulating regions and the conductivity ceramics material for electrode zone.Even if when branch contacts, insulating regions also prevents between the enclosed electrode of two seal jaws, form electric short circuit circuit.Axial clearance each other between the electrode of Liang Ge branch is 0.1mm to 0.3mm, preferably 0.25mm.In addition, provide electric current to having in the biological tissue of portion of tissue in seal jaw (i.e. the extension of current segment), and then improve hot biological effect.In addition, face at seal jaw and organize on the side of cavity volume and can provide nonmetallic materials, such as PTEE, plastic resin or analog.The electric current of cutting current concentrates on cutting electrode thus on the one hand, also concentrates on the tissue regions clamped between seal jaw on the other hand.Overcome tissue be bonded in organize the risk in cavity volume or greatly reduce tissue be bonded in the risk organized in cavity volume.
Cutting electrode support member can be formed by pottery, plastics or insulating coating metal.In addition, cutting electrode support member can have the surface that can not stick sticky tissue.As a result, the surface of cutting electrode support member can be formed in anti-stick sticky mode, such as coating.In addition, cutting electrode support member has high tracking resistance or high CTI (relative discharge tracking index) value, preferably higher than 600.Cutting electrode is preferably embodied as strip, and it carries exposed end face and fixes in electrode supporting piece or on electrode supporting piece through suitable device (particularly multiple foot).Thus the thermal inertia of cutting electrode is restricted to minimum.Flexibly can arrange reverse bearing (counterbearing), thus prevent Tissue approximation, and guide cutting by electric effect.This is of value to sealing reliability, this is due to by this way, the motion caused by tissue cutting between the cutting electrode and the reverse bearing of another branch of a branch can not cause the branch of same degree to move, and can not cause the motion between relative seal jaw.Alternatively or additionally, cutting electrode support member can be provided with spring.In this case, can fastening reverse bearing rigidly.
If cutting electrode support member is formed by plastics, so cutting electrode is preferably by plastic wraps molding.Cutting electrode can be made up of such as high-grade steel disc.The width of cutting electrode is preferably about 0.1mm.The thickness of the plastics on any side of cutting electrode is preferably about 0.15mm.Cutting electrode preferably stops and two of the side covering described electrode plastic walls (not having cut edge protuberance).Thermosetting resin is preferably used as plastics.Alternatively, the cutting electrode under unused state can give prominence to plastic wall a little, such as outstanding 0.02mm to 0.04mm.This protuberance can change during instrumentation, such as, change this protuberance by burning cutting electrode support member.
If cutting electrode support member is by pottery (preferably ZrO
2pottery) manufacture, so cutting electrode support member and cutting electrode separately manufacture in advance, and are then bonded together.The width of cutting electrode is preferably 0.2 to 0.25mm.It can be made up of sheet metal, particularly high-grade steel disc.Insulation wall on any side of cutting electrode preferably has the thickness of 0.15mm.The cut edge protuberance of preferred setting from 0.02mm to 0.04mm.Cutting electrode can lock mutually with cutting electrode support member, with cutting electrode support member block or with cutting electrode support member entirety bond.Generally gap is had between cutting electrode and the thin insulating wall of cutting electrode support member.This gap can be filled by binding agent, silicones or analog.Alternatively, cutting electrode can have lateral isolation portion, such as, by paint or coating (such as Parylene) is formed.Make the lateral contact face of cutting electrode insulate thus, and the impact of the fluid between cutting electrode and cutting electrode support member in gap on the cutting effect of cutting electrode is minimized (preferably preventing).
The reverse bearing be arranged on relative cutting electrode preferably can be provided with spring.Spring traverse can be fixed to and be less than 1mm, preferably 0.5mm.Reverse bearing is for keeping the chucking power between seal jaw.This is by being departed from and be clamped in cutting electrode and the tissue oppositely between bearing realizes by the tissue mechanical be clamped in the region of seal jaw.Shrink during being organized in cutting and sealing, also departed from the chucking power between seal jaw thus.This effect also occurs in the reverse bearing with rigid arrangement and is provided with in the embodiment of cutting electrode of spring.
When closed branch, upside or the tissue scaffold face of reverse bearing can be positioned in another plane compared with seal jaw.The cutting planes of cutting electrode protrudes past the seal jaw of the enclosed electrode be arranged in same branches.Thus, cutting process occurs in Different Plane compared with seal process.
When opening branch, reverse bearing can protrude past the seal jaw of same branches.When closed branch, the reverse bearing that elastic or elasticity is installed is compressed thereupon, thus is pressed in branch.Generate the spring force of antagonism cutting element thus.
Reverse bearing is preferably made up of the insulator with anti stick surface (such as PTFE makes), and has similar or identical anti creepage trace character compared with cutting electrode support member.The spring fitting of this reverse bearing causes cutting gap during cutting, have the cutting performance being suitable for tissue contracts.Elongated reverse bearing can have the elasticity independent of its far-end in its proximal end, thus when there is different tissues thickness along cutting electrode, can also limit wedge gap together with cutting electrode.
Add or alternatively, can spring fitting cutting element be passed through.Reverse bearing can be installed or similarly installs elastic movable in this case rigidly.Can also one of them of installation elements, thus can about lateral shaft pivotable and by other element of spring fitting, such as there is the element of spring traverse (being such as less than 0.5mm) little especially, thus for the different tissues intensity along cutting electrode, obtain the adaptability of good cutting electrode and reverse bearing.
At least following steps are preferably included for sealing with the method for chorista according to the present invention:
Grasping tissue between Liang Ge branch, thus make it be clamped between seal jaw, and be clamped between cutting electrode and tissue scaffold face, wherein, cavity volume is organized to be formed between closing seam jaw and cutting electrode support member, this tissue cavity volume is filled by tissue part at least in part, and supplies power on seal jaw and cutting electrode simultaneously.
Owing to providing electric energy at enclosed electrode and cutting electrode place simultaneously, so blood vessel sealing is separated (cutting) process with blood vessel occurs simultaneously.Blood vessel can be completed before completing blood vessel sealing to be separated.During blood vessel seal process, cavity volume is organized to protect the organization edge in branch, until thoroughly complete seal process.Have benefited from design according to branch of the present invention and the combination according to supply of electrical energy type of the present invention, operation process (particularly the separation of blood vessel and sealing) can perform out the highest quality.This whole processing procedure is very of short duration, and simultaneously this to start and general persistence is no longer than time of separately sealing due to sealing and cutting.
Accompanying drawing explanation
According to Figure of description or claims, the further details of advantageous embodiment of the present invention can be obtained.In the accompanying drawings:
Fig. 1 illustrates sealing instrument in the mode of schematic isometric complete diagram;
Fig. 2 illustrates the instrument of the sealing instrument according to Fig. 1 in the mode of amplifying three-dimensional schematic partial cross-sectional view;
Fig. 3 shows the instrument being in closure state according to Fig. 2 in the mode of cross sectional view;
Fig. 4 shows the instrument when sealing and be separated hollow blood vessel according to Fig. 3;
Fig. 5 shows the cutting electrode of the instrument according to Fig. 2 in the first embodiment in the mode of perspective partial cross-sectional schematic diagram;
Fig. 6 shows the cutting electrode according to Fig. 5 in the mode of cross sectional view;
Fig. 7 shows the revision for execution example of cutting electrode and cutting electrode support member in the mode of longitudinal cross-section view; And
Fig. 8 shows another revision for execution example of cutting electrode in the mode of perspective diagram.
Detailed description of the invention
Fig. 1 shows the apparatus 10 with slender axles 11, carries instrument 12 at its far-end.The near-end of this axle 11 is connected to housing 13, it arranges the actuation element 14 for mobile and actuation tool 12.Apparatus 10 is sealing instrument.Therefore, instrument 12 is for sealing and suitably split tissue, wherein, comprises blood vessel in the tissue and tube chamber will be closed and seal at produced organization edge place thus.
The instrument 12 be provided on apparatus 10 is formed in a particular manner.It has the first branch 15, and it is top set and the second branch 16 in fig. 2, and be inferior division in fig. 2, wherein at least one is installed pivotly about pivotal axis 17.At this moment, according to application, the first branch 16 of branch 15, second can be installed or Liang Ge branch 15,16 can, about identical or different said pivot or movement, make branch 15,16 close to each other or remotely to move.
In the mode of cross sectional view, branch 15,16 is shown again respectively in figs. 3 and 4.First branch 15 can such as be formed by metal or resist bending other metal materials resistant to bending.It has the main body 18 with U exterior cross-section.This main body 18 has two the first seal jaws 19,20, and it extends parallel to each other, preferably electric interconnection, and between define groove 21.This groove preferably extends in most of length of the first branch 15, and for holding cutting electrode support member 22.This support member 22 has pedestal 23, and the profile of itself and groove 21 matches and places regularly wherein in a static manner, irremovable.Wall-like extension 24 extends away from pedestal 23 from seat surface 23a, and its cross section is such as rectangle, is preferably located in the centre position of two seal jaws 19,20, thus described extension is given prominence to from groove 21.Groove 21 is by seal jaw 19, and the edge of 20 limited, and forms enclosed electrode 25,26 thereon.Respectively from seal jaw 19, the 20 seat surface 23a started, 23b extend to same with extension 24 far away, and are arranged on relative to enclosed electrode 25, the back side of 26.Enclosed electrode 25,26 can be connected in main body 18 conductively.Can especially as seen from Figure 2, enclosed electrode 25,26 preferably form the spaced conduction one side of a line, and they are by insulating regions 27, and 28 are separated from each other.Branch 15 can add has electric insulation coating layer 29, thus makes electric current in importing branch 15 can only at enclosed electrode 25, and 26 places import in biological tissue 30 (Fig. 4).At insulating coating 29 and insulating regions 27, between 28, preferably there is gap, thus the material of enclosed electrode can not be insulated in this region.Thereby is achieved good airtight quality.
Cutting electrode support member 22 has cutting electrode 31, and it is arranged on the end face of described support member.At this moment, cutting electrode 31 be placed on wall-like extension 24 groove or depression in, wherein, cutting electrode 31 exposes through end face 32.Cutting electrode 31 is accommodated in two groove walls 33, between 34.Groove walls 33,34 preferably have approximately equal with cutting electrode 31 width.Fig. 6 is please refer to about this point.The width B of cutting electrode 31 can be in from the scope of 0.05 to 0.25mm, and is preferably 0.1mm.Isolation recesses wall 33,34 preferably has the thickness of formed objects.Such as, they have the thickness of 0.15mm.Except a little protuberance, they are connected with the other side each other and stop.Exceed groove walls 33, the protuberance U of the end face 32 of the cutting electrode 31 of the end face of 34 only has tens microns (μm), such as, and 0 to 40 μm.
The length of the wall-like extension 24 measured by from pedestal 23 to cutting electrode 31 preferably makes end face 32 exceed seal jaw 19, and 20 outstanding such as 0.5 to 1mm, therefore preferred 0.9mm.When closed branch, the tissue scaffold face 44 of the second branch 16 is approximately pressed into same distance in the second branch 16 by the wall-like extension 24 of the first branch 15, and in this state, seal jaw 19,36 and 20,37 contact with each other or almost contact.This distance illustrates with size T at the right-hand side on instrument 12 side in figure 3.
Fig. 3 also show the second branch 16, and it similarly has the main body 35 be preferably made up of conductive material.This main body 35 has U-shaped cross section equally, and wherein, groove 38 is formed in two the second seal jaws 36, between 37.Enclosed electrode 39,40 (Fig. 2) are formed in the second seal jaw 36 of the second branch 16 of preferred electric interconnection equally, and on 37, and along seal jaw 36, the top edge of 37 is arranged to a line.The insulating regions 27,28 of the first branch 15 is smaller than along the enclosed electrode 39,40 measured by seal jaw longitudinal direction.Similarly, the enclosed electrode 25,26 along the first branch 15 measured by seal jaw longitudinal direction is smaller than insulating regions 61,62, namely at the second enclosed electrode 39 of the second branch 16, and the distance between 40.In addition, the first enclosed electrode 25,26 is placed in the first branch 15, thus makes them in closed branch 15, is arranged in the second enclosed electrode 39 when 16, and between 40, that is, they contact the insulating regions 61,62 of the second branch 16.Therefore the electric short circuit between the first branch 15 and the second branch 16 is prevented.
Second branch 16 as shown in Figure 3 can then provide insulating coating 41.Reverse bearing 42 for cutting electrode 31 is arranged in groove 38.Reverse bearing 42 can be parallel to seal jaw 36, and 37 install movably, and is such as pressed in groove 38 under the power effect of spring element 43, such as, and the power of antagonism spring element 43.Reverse bearing 42 is such as banded element, is made up of, preferably has smooth tissue scaffold face 44 plastics, pottery or other electrical insulator, it forms the supporting surface being used for biological tissue 30, and is arranged in enclosed electrode 39 when being in all the other positions, below 40, that is, in groove 38.Tissue scaffold face 44 extends to seal jaw 37 from seal jaw 36.If necessary, tissue scaffold face 44 can also be formed with structure shape or in the mode of shaped form or their combinations.
Spring element 43 can be Compress Spring, and its one end is supported on the bottom of groove 38, and other end place is operably connected to reverse bearing 42.Along branch 16, multiple such Compress Spring can also be arranged to a line.Alternatively, elastomer element can be placed as spring or be fastened on the bottom of groove, and reverse bearing 42 is supported on elastomer element.The spring traverse of reverse bearing 42 can be relatively low, and such as can be restricted to and be less than 1 millimeter, preferably 0.5mm.The spring traverse of reverse bearing depends on spring element 43.Can reduce this traverse by the spring element 43 of predetermined load, such as, reduce to 0.5mm or less, and by the spring element 43 of non-predetermined load, this traverse also comprises the path with produced predetermined load, and can be 1mm or more.Alternatively, the function of reverse bearing 42 and spring element 43 can be provided in single parts, the parts such as formed by elastomer.
Seal jaw 36, the upside of 37 is circular.With the seal jaw 19,20 of the first branch 15 together, they work in pairs thus limit gap 45,46 in each case, and the orientation in this gap is shown by chain-dotted line 47,48 in figure 3.Gap 45, the orientation of 46 can by being provided in seal jaw 19,20,36, and the flattened side 49,50,51 on 37,52 determine.Fixing and by line 47, summit or the intersection point of 48 directions limited and intersection S together form obtuse angle, and this intersection point illustrates the summit at obtuse angle by gap 45,46.It points to cutting electrode 31.Obtuse angle is preferably in from the scope of 130 ° to 150 °.
In addition, the geometric form determined by function of instrument 12 comprises two and organizes cavity volume 53,54.They are formed on any side of wall-like extension 24, and comprise the region of groove 21 and 38.They are limited between the tissue scaffold face 44 of pedestal 23 and reverse bearing 42 vertically.This vertical extension V is shown in Figure 3, and is in the scope of such as 0.7mm to 2.5mm when closing branch not having tissue, preferably 1.4mm.Gap 45,46 are arranged in the substantial middle relative to the vertical extension V organizing cavity volume 53 or 54, or are preferably arranged to depart from a little towards seat surface 23a.
Organize cavity volume 53 for two, 54 are preferably equivalent size.They have horizontal extension H, and it passes through at wall-like extension 24 and corresponding seal jaw 19,36 and 20, and the distance between 37 is determined.This horizontal extension H is preferably larger than the thickness of the extension 24 measured along equidirectional.These organize the horizontal extension of one of them of cavity volume to be approximately preferably 0.2 to 0.6 times of vertical extension.When closed branch 15, when 16, what be preferably rectangle organizes cavity volume 53, the cross section of 54 is formed as follows: the direction of motion B between the tissue scaffold face 44 and the seat surface 23a of pedestal 23 of reverse bearing 42, also transverse at extension 24 and the first seal jaw 19, direction of motion B between 36 and at extension 24 and the second seal jaw 20, the direction of motion B between 37.
Apparatus described in this respect serves following effect:
In order to seal and chorista, particularly hollow blood vessel or comprise the tissue of hollow blood vessel, in branch 15, clamps this tissue between 16.By the suitable actuating of actuation element 14, branch 15,16 move towards one another, thus biological tissue clamped 30 as illustrated in fig. 4.Tissue 30 bears seal jaw 19,36 and 20, the pressure between 37 during this process, and described in be organized in and organize cavity volume 53, the pressure be subject in 54 alleviates relatively.But cutting motor 31 also applies high pressure on tissue 30.
In order to seal tissue, in branch 15, voltage (preferably applying high-frequency ac voltage) is applied between 16, thus the electrode 25 making electric current pass through in the first branch 15,26 and second electrode 39 of branch 16, biological tissue between 40, to heat described tissue and to make clamped tissue fusion.Meanwhile, cutting electrode 31 is activated.Also service voltage (preferably HF voltage), its reference potential is positioned at one of branch 15,16 (preferably in the second branch 16), is also namely positioned at enclosed electrode 39,40.
Because cutting electrode has small size, be preferably approximately 1mm
2to 3mm
2cutting electrode small size, so be sufficiently high in the electric current density at end face 32 place, separately biological tissue fast thus.The tissue shunk below cutting electrode 31 is supported by the reverse bearing 42 of elasticity.Described tissue presses to end face 32 by tissue scaffold face 44, thus makes it continue to keep the contact with cutting electrode 31.But electric current density significantly reduces in the short distance of distance end face 32.Can for the side-walls cross section of the extension 24 of electric current from the alternation of cross-section of narrow gap for organizing cavity volume 53, or the wide cross section of 54.Biological tissue provided herein thus only faint heating and compared with the tissue below end face 32 shrinkage degree less.Sealing the margin, thus respectively at often pair of seal jaw 19,36 and seal jaw 20, is formed between 37, and in sealing the margin, all tube chambers of closing tissue 30 also form the connection of weld seam shape in the tissue.Tissue simultaneously or after a while separately below cutting electrode 31.If closed branch 15,16, be placed on and organize cavity volume 53, the roll of tissue frontier defense in 54 stops tissue 30 and departs from from instrument 12.Only just discharge organization edge when opening instrument and complete processing procedure.
The main task during tissue 30 processes is performed by cutting electrode 31 and cutting electrode support member 22.Large as far as possible organize cavity volume 53 to be formed, 54 and make instrument 12 overall width minimum, the overall width G (Fig. 6) of wall-like extension 24 should be little as far as possible.It preferably has the size of tens millimeters.So also there is following effect: the electric current density only below cutting electrode 31 has the value that is enough to separately tissue and then significantly reduces, thus formed to be placed on and organize cavity volume 53, the crimping in 54.
Fig. 5 shows the distortion of the cutting electrode be made up of pottery.Wall-like extension 24 on its end face has the groove 55 wherein placing banded cutting electrode.Preferably have multiple fastening extension 56,57, it extends through the opening of cutting electrode support member 22.Arrangement of electrodes formed thus adhesively can bind the cutting electrode support member 22 that pottery is formed.One or more fastening extension 56,57 can be connected to electric current supply on the electric wire 58 of cutting electrode 31 at pedestal 23 place.
Regardless of specific design, cutting electrode support member 22, at cutting electrode 31 and enclosed electrode 25,26,39, causes potential isolation between 40.But enclosed electrode 39 and 40 such as uses as neutral electrode, can to enclosed electrode 25,26 effects cause the voltage sealed, and described voltage is preferably lower than the voltage being supplied to and cutting electrode 31 being also intended to separately tissue.Enclosed electrode 25,26,39,40 preferably have total electrode area, its 10 times areas being greater than (preferably 20 times be greater than) end face 32, thus the electric energy of supply are are only cut and organized and can not at enclosed electrode 25 at end face 32 place, 26,39,40 places are tissue separately.
Fig. 7 shows the revision for execution example of cutting electrode support member 22.Cutting electrode 31 is placed in the groove of cutting electrode support member equally, and is fixed by elastic foot 59.The main body of cutting electrode support member 22 can be made up of pottery or plastics.Particularly at high temperature stable thermosetting resin or silicones can be fire-retardant and tolerate spark eroding, and have the CTI being suitable as plastics higher than 600.In addition, it should have sufficiently high mechanical strength and the heat conductivity higher than 1W/mK.
Such plastics can provide the electrode panel 60 according to Fig. 8 especially.Cutting electrode 31 here in other embodiments all can be made up of sheet metal (such as high-grade steel).The input low in calories be connected and in plastics is obtained in plastics and electrode panel 60 by the multiple windows be provided in electrode panel 60.
The operating theater instruments 10 being used in particular for delicate procedure has the Liang Ge branch 15,16 of band seal jaw 19,20,36,37, can apply hermetic (being preferably applied to the voltage between 80 to 120 volts) to it.Be separated from each other organize cavity volume 53 by the wall-like extension 24 at its lower edge carrying cutting electrode 31,54 are limited between branch 15,16.Be applied between branch 16 and cutting electrode from the killer voltage of 300 to 500 volts.When closed branch, clamped is organized in seal jaw 19,36 and 20, seals between 37 simultaneously and separated by cutting electrode 31.Even if will organize to separate completely and seal after such as 0.3 to 0.5 second and need the longer time (about 1.5 to 3.5 seconds of overall time), the blood vessel that still can realize having closed seal blood vessels end will be separated.Here, organize cavity volume 53,54 protect as the form fit of separated blood vessel end, guarantee thus in instrument 12, form the closed blood vessel end with organization edge.This blood vessel end is weak or can not be solidified compared with seal area, thus form the thickening area of similar crimping, and it prevents the organization edge when closed described apparatus from spinning off from apparatus.
Reference list:
| 10 | Apparatus |
| 11 | Axle |
| 12 | Instrument |
| 13 | Housing |
| 14 | Actuation element |
| 15 | First branch |
| 16 | Second branch |
| 17 | Pivotal axis |
| 18 | The main body of the first branch 15 |
| 19，20 | First seal jaw |
| 21 | Groove |
| 22 | Cutting electrode support member |
| 23 | The pedestal of cutting electrode support member |
| 23a | Seat surface |
| 24 | The wall-like extension of cutting electrode support member |
| 25，26 | The enclosed electrode of the first branch |
| 27，28 | The insulating regions of 15 |
| 29 | Electric insulation coating layer |
| 30 | Biological tissue |
| 31 | Cutting electrode |
| 32 | End face |
| 33，34 | Groove walls |
| B | The width of cutting electrode |
| U | Protuberance |
| 35 | Main body |
| 36，37 | Second seal jaw |
| 38 | Groove |
| 39，40 | The enclosed electrode of the second branch |
| 41 | Insulating coating |
| 42 | Reverse bearing |
| 43 | Spring element |
| 44 | Tissue scaffold face |
| 45 | Gap between seal jaw 19 and 36 |
| 46 | Gap between seal jaw 20 and 37 |
| 47 | The line of gap 45 orientation is shown |
| 48 | The line of gap 46 orientation is shown |
| 49-52 | Side |
| 53，54 | Organize cavity volume |
| V | Organize cavity volume 53, the vertical extension of 54 |
| H | Organize cavity volume 53, the horizontal-extending of 54 |
| 55 | Groove |
| 56，57 | Fastening extension |
| T | Exceed the protuberance of the cutting electrode of enclosed electrode |
| 58 | Electric wire |
| 59 | Foot |
| 60 | Electrode panel |
| 61，62 | The insulating regions of 16 |
Claims (15)
1. an operating theater instruments (10), comprising:
First branch (15), described first branch (15) has and is arranged to two the first seal jaws (19,20) separated by a distance, described first seal jaw (19,20) the first groove (21) is limited out between
The cutting electrode support member (22) of electric insulation, described cutting electrode support member (22) has pedestal (23), described pedestal (23) is arranged in described groove (21), and described pedestal (23) has seat surface (23a), described seat surface (23a) is relative to being arranged in described first seal jaw (19, 20) enclosed electrode (25 on, 26) the back side, and wall-like extension (24) is with described first seal jaw (19 with described first branch (15), 20) become distance ground mode to leave described seat surface (23a) to extend,
Cutting electrode (31), described cutting electrode (31) embeds in described cutting electrode support member (22), exposes end face (32),
Second branch (16), described second branch (16) has two seal jaws (36,37), described seal jaw (36,37) setting in a certain distance apart from one another, and described seal jaw limits the second groove (38) between (36,37)
Wherein, described branch (15,16) can be close to each other or remotely move along the direction of motion (B), so that closed and open,
There is the reverse bearing (42) be arranged in for described cutting electrode (31) in described second groove (38), wherein, described reverse bearing (42) has tissue scaffold face (44), described tissue scaffold face (44) is configured to when closed described branch (15,16) time, relative to the enclosed electrode (39 of described seal jaw (36,37), 40) setting is stepped back at the back side
Wherein, organize cavity volume (53, 54) so formed: when closed described branch (15, 16) time, describedly organize cavity volume (53, 54) along the direction of motion (B) between the described tissue scaffold face (44) and the described seat surface (23a) of described pedestal (23) of described reverse bearing (42), and laterally to described extension (24) and described first seal jaw (19, 36) direction of motion (B) between and be positioned at described extension (24) and described second seal jaw (20, 37) direction of motion (B) between.
2. apparatus according to claim 1, is characterized in that, described cavity volume (53,54) of organizing has along described extension (24) and described seal jaw (19,36; 20,37) width (H) of the described direction of motion (B) cross measure between, described width is less than the height measured along the described direction of motion (B) between described reverse bearing (42) and described pedestal (23).
3. according to the apparatus in aforementioned claim described in any one, it is characterized in that, described cavity volume (53,54) of organizing has along described extension (24) and described seal jaw (19,36; 20,37) width (H) of the described direction of motion (B) cross measure between, described width is greater than the thickness of the described wall-like extension (24) of measuring along equidirectional.
4. according to the apparatus in aforementioned claim described in any one, it is characterized in that, described seal jaw (19,36; 20,37) there is the cross section profile with annular transitional.
5. according to the apparatus in aforementioned claim described in any one, it is characterized in that, seal jaw (19,36 described in every a pair; 20,37) seal clearance (45,46) is all defined.
6. apparatus according to claim 5, is characterized in that, in often kind of situation, and paired described two seal jaws (19,36; 20,37) two the described seal clearances (45,46) formed form obtuse angle (β) each other.
7. apparatus according to claim 6, is characterized in that, angle (β) has the summit (S) pointing to described cutting electrode.
8. according to the apparatus in aforementioned claim described in any one, it is characterized in that, each described seal jaw (19,36; 20,37) have at least one insulating regions (27,28,61,62), described insulating regions is embarked on journey and is arranged between described enclosed electrode (25,26,39,40).
9. apparatus according to claim 8, is characterized in that, described seal jaw (19,20; 36,37) described enclosed electrode (25,26; 39,40) electric interconnection.
10. apparatus according to claim 8, is characterized in that, described seal jaw (19,20 positioned opposite in pairs; 36,37) described enclosed electrode (25,26; 39,40) arrange in the mode do not overlapped each other.
11., according to the apparatus in aforementioned claim described in any one, is characterized in that, described cutting electrode support member (22) is formed by pottery or plastics.
12. according to the apparatus in aforementioned claim described in any one, it is characterized in that, described cutting electrode (31) comprises the continuous strip of the end face (32) supporting described exposure, described band is fixed in described electrode supporting piece (22) through multiple fastening extension (56,57).
13. according to the apparatus in aforementioned claim described in any one, it is characterized in that, described cutting electrode (31) comprises the continuous strip of the end face (32) supporting described exposure, and described band is fixed in described electrode supporting piece (22) through multiple elastic foot (59).
14. according to the apparatus in aforementioned claim described in any one, it is characterized in that, described cutting electrode support member (22) is arranged in described first groove (21) rigidly, and described reverse bearing (42) is movably disposed within the second groove (38), or described electrode supporting piece (22) is movably disposed within described first groove (21), and described reverse bearing (42) is by rigidly or be movably disposed within the second groove (38).
15. 1 kinds for sealing the method with chorista, wherein, in the process:
Grasping tissue between Liang Ge branch (15,16), thus make described tissue be clamped in seal jaw (19,36; 20,37) between and be positioned between cutting electrode (37) and tissue scaffold face (44), wherein, cavity volume (53,54) is organized to be formed in closed described seal jaw (19,36; 20,37) and between cutting electrode support member (22); And
Simultaneously to described seal jaw (19,36; 20,37) and described cutting electrode (37) power supply.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| EP14173954.0A EP2959854B1 (en) | 2014-06-25 | 2014-06-25 | Surgical instrument |
| EP14173954.0 | 2014-06-25 |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CN105310769A true CN105310769A (en) | 2016-02-10 |
| CN105310769B CN105310769B (en) | 2018-04-24 |
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| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN201510359500.9A Active CN105310769B (en) | 2014-06-25 | 2015-06-25 | Operating theater instruments |
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| Country | Link |
|---|---|
| US (1) | US10130414B2 (en) |
| EP (1) | EP2959854B1 (en) |
| JP (1) | JP6216741B2 (en) |
| KR (2) | KR102003099B1 (en) |
| CN (1) | CN105310769B (en) |
| BR (1) | BR102015015264B1 (en) |
| PL (1) | PL2959854T3 (en) |
| RU (1) | RU2618186C2 (en) |
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| CN103813762A (en) * | 2011-09-16 | 2014-05-21 | 蛇牌股份公司 | Electrosurgical instrument |
| US20130226177A1 (en) * | 2012-02-24 | 2013-08-29 | Tyco Healthcare Group Lp | Vessel Sealing Instrument with Reduced Thermal Spread and Method of Manufacture Therefor |
Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN110234283A (en) * | 2017-01-18 | 2019-09-13 | 奥林巴斯株式会社 | Treatment apparatus |
| CN112386286A (en) * | 2019-08-14 | 2021-02-23 | 厄比电子医学有限责任公司 | Dissection electrode, surgical instrument and method for manufacturing a cutting electrode |
Also Published As
| Publication number | Publication date |
|---|---|
| JP6216741B2 (en) | 2017-10-18 |
| KR20170021817A (en) | 2017-02-28 |
| JP2016007542A (en) | 2016-01-18 |
| BR102015015264B1 (en) | 2022-01-25 |
| RU2618186C2 (en) | 2017-05-02 |
| BR102015015264A2 (en) | 2017-12-19 |
| US20150374430A1 (en) | 2015-12-31 |
| PL2959854T3 (en) | 2018-07-31 |
| KR20160000874A (en) | 2016-01-05 |
| CN105310769B (en) | 2018-04-24 |
| EP2959854A1 (en) | 2015-12-30 |
| US10130414B2 (en) | 2018-11-20 |
| RU2015124783A (en) | 2017-01-10 |
| EP2959854B1 (en) | 2018-03-21 |
| KR102003099B1 (en) | 2019-07-23 |
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